Peroneal Tendon Injuries
![Peroneal]()
What Are
the Peroneal Tendons?
A tendon
is a band of tissue that connects a muscle to a bone. The two peroneal tendons
in the foot run side-by-side behind the outer ankle bone. One peroneal tendon
attaches to the outer part of the midfoot, while the other tendon runs under
the foot and attaches near the inside of the arch. The main function of the
peroneal tendons is to stabilize the foot and ankle and protect them from
sprains.
Causes
and Symptoms of Peroneal Tendon Injuries
Peroneal tendon injuries may be acute (occurring suddenly)
or chronic (developing over a period of time). They most
commonly occur in individuals who participate in sports that involve repetitive
ankle motion. In addition, people with higher arches are at risk for developing
peroneal tendon injuries. Basic types of peroneal tendon injuries are
tendonitis, tears, and subluxation.
Tendonitis is an inflammation of one or
both tendons. The inflammation is caused by activities involving repetitive use
of the tendon, overuse of the tendon, or trauma (such as an ankle sprain).
Symptoms of tendonitis include:
- Pain
- Swelling
- Warmth
to the touch
Acute tears are caused by repetitive
activity or trauma. Immediate symptoms of acute tears include:
- Pain
- Swelling
- Weakness
or instability of the foot and ankle
As time goes on, these tears may lead to a change in the
shape of the foot, in which the arch may become higher.
Degenerative tears (tendonosis) are
usually due to overuse and occur over long periods of time – often years. In
degenerative tears, the tendon is like taffy that has been overstretched until
it becomes thin and eventually frays. Having high arches also puts you at risk
for developing a degenerative tear. The symptoms of degenerative tears may
include:
- Sporadic
pain (occurring from time to time) on the outside of the ankle
- Weakness
or instability in the ankle
- An
increase in the height of the arch
Subluxation – one or both tendons have
slipped out of their normal position. In some cases, subluxation is due to a
condition in which a person is born with a variation in the shape of the bone
or muscle. In other cases, subluxation occurs following trauma, such as an
ankle sprain. Damage or injury to the tissues that stabilize the tendons
(retinaculum) can lead to chronic tendon subluxation. The symptoms of subluxation
may include:
- A
snapping feeling of the tendon around the ankle bone
- Sporadic
pain behind the outside ankle bone
- Ankle
instability or weakness
Early treatment of a subluxation is critical, since a tendon
that continues to sublux (move out of position) is more likely to tear or
rupture. Therefore, if you feel the characteristic snapping, see a foot and
ankle surgeon immediately.
Diagnosis
Because peroneal tendon injuries are sometimes misdiagnosed and may worsen
without proper treatment, prompt evaluation by a foot and ankle surgeon is
advised. To diagnose a peroneal tendon injury, the surgeon will examine the
foot and look for pain, instability, swelling, warmth, and weakness on the
outer side of the ankle. In addition, an x-ray or other advanced imaging
studies may be needed to fully evaluate the injury. The foot and ankle surgeon
will also look for signs of an ankle sprain and other related injuries that
sometimes accompany a peroneal tendon injury. Proper diagnosis is important
because prolonged discomfort after a simple sprain may be a sign of additional
problems.
Non-Surgical
Treatment
Treatment depends on the type of peroneal tendon injury. Options include:
- Immobilization. A
cast or splint may be used to keep the foot and ankle from moving and
allow the injury to heal.
- Medications. Oral
or injected anti-inflammatory drugs may help relieve the pain and
inflammation.
- Physical
therapy. Ice, heat, or ultrasound therapy may be used to
reduce swelling and pain. As symptoms improve, exercises can be added to
strengthen the muscles and improve range of motion and balance.
- Bracing. The
surgeon may provide a brace to use for a short while or during activities
requiring repetitive ankle motion. Bracing may also be an option when a
patient is not a candidate for surgery.
When is
Surgery Needed?
In some cases, surgery may be needed to repair the tendon or tendons and
perhaps the supporting structures of the foot. The foot and ankle surgeon will
determine the most appropriate procedure for the patient’s condition and
lifestyle. After surgery, physical therapy is an important part of
rehabilitation.
Information provided by The American College of Foot and Ankle Surgeons